Jim Ramstad calls for more extensive mental health coverage

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WASHINGTON — In fall 2008, with the economy collapsing around them, members of Congress worked quickly on a bailout for the nation’s banks.

Lawmakers needed an existing bill to act a vehicle for the bailout, and the one they picked was named for the late Sen. Paul Wellstone and introduced by Minnesota’s Jim Ramstad, requiring health insurance plans to provide equal coverage for mental health and substance abuse treatments as they do for physical aliments. President Bush signed the bill into law on Oct. 3, 2008.

Nearly four years later, after it was expanded, in part, by the Affordable Care Act in 2010, the bill’s supporters say federal regulators have moved too slowly in instituting rules that ensure the bill’s mission is carried out. Ramstad and the bill’s co-sponsor, former Democratic Rep. Patrick Kennedy, were in Washington on Wednesday to announce a series of field hearings to put pressure on them to do just that. The first confirmed hearing is scheduled for July 17 in the Twin Cities.

“The reality of this effort is that we’re not there yet,” Ramstad said in a speech at the National Press Club. “It’s about time we treat diseases of the brain the same as diseases of the body.”

Last year, federal regulators put in place interim rules for implementing the bill, called the Mental Health Parity Act. Kennedy said at least one-third of affected employers have already changed their healthcare plans so they conform with the law, by providing equal coverage for mental health and substance abuse programs as they do for physical treatments and ensuring similar financial requirements (such as co-pays and deductibles) for the two types of care.

Vague rules

But advocates say that the interim rules are overly vague and allow too many companies to avoid changing their plans. When regulators eventually put forward their final parity rules — there’s no set timetable for them to do so, and observers say it’s unlikely they will before this fall’s elections — advocates want them to be stronger than they are now.

“I don’t know [why it’s taken so long]. We have been very, very frustrated,” Ramstad said. “I’ve asked probably 100 people and gotten probably 100 different answers.”

Regulators from the Treasury, Labor and Health and Human Service Departments put together the rules that are now under fire and Obama administration officials committed to working with Ramstad and Kennedy to institute stronger rules and participate in this summer’s field hearings. Pam Hyde, the head of the Substance Abuse and Mental Health Services Administration, said her department would use the hearings as a chance to walk employers and health care providers through the new regulations.

“No law and no regulation is going to be as good as it can be unless we get the word out that it’s there and that it can be used,” Hyde said.

Part of the problem also rests is in how the bill was written — those affected by the parity law, primarily insurance companies, say it’s too vague and are moving slowly to adapt it, but Ramstad says that criticism comes with any new law.

“Opponents can always argue vagueness. That’s a standard argument you learn in Poli Sci 101 or first-year legislative process in law school,” Ramstad said. “There are parts that could have been stronger, but it was a collaborative effort. If I wrote the bill unilaterally, it would have been stronger, if Patrick Kennedy had written the bill unilaterally it would have been stronger.”

Advocates have a long list of ways in which they’d strengthen the law. The Parity Implementation Coalition has identified four main areas where the rules fall short, mostly relating to how insurance companies approve the necessity and form of mental health and substance abuse treatments and expanding the scope of benefits offered (beyond a slate of inpatient, outpatient, prescription drugs and emergency care services already provided).

For his part, Ramstad said he’d like to see the rules extend to Medicare and Medicaid patients as well as members of the armed services returning from the Middle East. As it stands now, mental health parity is only required for those in health care plans.

“We want to see teeth in the parity law,” Ramstad said. “I know in my heart and whatever Norwegian intellect that I have left that we can get this done.”

Devin Henry can be reached at dhenry@minnpost.com. Follow him on Twitter: @dhenry

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